How to stop the killer

Universities have received new advice on tackling meningitis - a disease that attacks first-year students disproportionately, says Lucy Hodges. Will it prevent another outbreak?

In 1996, an outbreak of meningitis among students at the University of Cardiff shocked the higher-education world. There were seven cases and two deaths. The following year, six students contracted the disease at University of Southampton and three of them died.

In 1996, an outbreak of meningitis among students at the University of Cardiff shocked the higher-education world. There were seven cases and two deaths. The following year, six students contracted the disease at University of Southampton and three of them died.

Universities woke up to the threat posed by this acute infectious disease which affects first-year undergraduates disproportionately, particularly those living in halls of residence, and strikes in the winter months. As many as 2,000 cases of meningococcal meningitis are reported each year. It is difficult to diagnose because its initial symptoms are flu-like - fever, aches and pains - but it is clear that if it isn't diagnosed and treated quickly with antibiotics, it can lead to death within days.

Until those two outbreaks, there had been isolated cases of meningitis, according to Peter Reader, who was head of public affairs at Southampton at the time. The 1997 cases were a bombshell for the university. "Any death is devastating," says Reader, who is now director of marketing and communications at the University of Bath. "Because Southampton had previous cases of meningitis, we thought that we were prepared. But nothing could prepare us for the sequence of events that led us to being faced with three deaths in a short period of time."

The first student to die was Mellissa Irvine, after only two weeks of her first term, on 11 October 1997; the second, whose name has never been released, died on 27 October; the third, Charlotte Simpkin, died six days later. This third death prompted an inquiry into Southampton General Hospital because Simpkin had been admitted to hospital, and died three days later after having been taken off antibiotics.

The university was exonerated. It reacted to the outbreak by going into information overdrive, giving out as much data as it could to students, parents and the media. "It is absolutely essential that students understand that this is something that is rare," says Reader. "Nevertheless, it is still potentially a killer, unlike mumps which only kills in really extreme cases."

But people were very worried. So the university established a helpline operated by staff from 8.30am to after 11pm every day. In the peak week of the crisis, beginning on 3 November, staff received more than 1,750 calls on the helpline. "There was a lot of sadness that we had lost three students but there was also a lot of concern for the welfare of students and staff," says Reader. "One of the things we felt we could do was to keep information as up-to-date and fresh as possible."

The university also held an immunisation campaign. At the time there was a vaccine available for the group C strains of meningitis and this was administered (a new group C vaccine has since been introduced, but there is still no vaccine for the most common strain, group B). Because the first five cases were in Wessex Lane halls of residence, all 1,800 students in those halls were offered injections. That campaign was extended to cover all first-year students and all those living in halls. Later - because of the concern about the disease - it was extended to all other students and members of staff.

When the dust had settled, Universities UK, the umbrella group for higher education, issued guidelines on how institutions should handle the disease. These pointed out the need for them to call key people together to agree a plan of action in the event of an outbreak, including the dispensing of antibiotics and vaccines and the giving out of leaflets. The guidelines have just been updated, taking into account the latest information. They include new sections on how to raise awareness of the disease among students and what should be done if a student is taken ill.

Universities are advised to send out information and advice on meningitis in students' joining packs. All UK undergraduates should already have been offered the MenC vaccine at school or college during the academic year 1999-2000. At the start of the university year, all students should acquaint themselves with the symptoms of the disease, the guidelines advise; they should register with a general practice and inform the warden of their hall of residence of their doctor's name; they should look out for one another's welfare; and they should tell someone (a friend or hall warden) if they are feeling ill so that they can be monitored if their condition deteriorates.

"When a doctor is called to see an ill student, it is important that a friend or warden is aware of this," say the guidelines. "If the doctor advises that the student be kept under observation, it is vital that clear arrangements are made by the doctor for regular monitoring by duty warden, flat-mate or friend (suggested frequency three to four hours). In halls of residence, standing arrangements for monitoring a student with possible symptoms of meningitis are essential. This is especially important at night-time."

These lessons were followed in the case of Alex Bottomley, 22, who graduated from Liverpool University last summer and contracted the disease three weeks into his first year. "I had snogged someone," he says. "Then I went on a long weekend doing territorial army training which was physically very taxing. I had a long, hard, day and got hammered in the evening. Next morning I felt like I had a horrific hangover, my temperature was up and down and I felt dizzy."

But, like many, Bottomley didn't seek help at that stage. He returned to university at the end of the weekend and went to bed. When he awoke the next morning, he had the classic symptoms: red blotches all over this body. He knew that if he pressed the rash against a glass and the blotches didn't fade, he was in trouble. They didn't fade, so he sought help immediately from the hall tutor and was rushed to hospital.

A more recent case at Sussex University did not have a happy ending. The student was diagnosed at university as having the disease. She went home, and was taken to hospital but the hospital didn't take the disease seriously and she died. "You're not going to prevent all the deaths because sometimes it develops so rapidly and overwhelmingly," says Dr James Stewart, director of the Health Protection Agency (South West), who is responsible for the new guidelines. "But there are situations where you think if you could have started earlier you could have made a difference."

THE DANGER SIGNALS

Any of these signs can spell danger and urgent help should be sought. If meningitis is the cause, a delay could be fatal

* a rash that does not fade when pressed with a glass

* loss of consciousness

* severe neck stiffness

* unusually cold hands and feet

* unusually severe and worsening headache

l.hodges@independent.co.uk